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Tourette’s Syndrome

Aug 09, 2004 Viewed: 786

What Is It?

Tourette’s syndrome is a neurological disorder (a problem with the nervous system), in which the major symptom is tics. Tics are sudden, brief, involuntary movements (motor tics) or sounds (vocal tics). In Tourette’s syndrome, both types of tics are present.

Named after the French physician who first described it in the 19th century, Tourette’s is believed to be an inherited condition that runs in families. It often is accompanied by other behavioral or emotional problems, for example, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, learning difficulties, sleep problems, depression, anxiety, and behavior problems.

Tics are relatively common, but Tourette’s syndrome is less common. Tics occur in one out of 100 people, whereas the full Tourette’s syndrome occurs in one of every 2,000. Boys are affected more often than girls.

Tics are involuntary and usually sudden, rapid, and repetitive. They appear in a variety of forms. No two people with Tourette’s syndrome have the same symptoms.

Tics fluctuate over time. They become worse with anxiety, excitement, anger or fatigue, and can get better during absorbing activities or sleep. Some people with Tourette’s describe an urge or warning sign before a tic. They may be able to suppress tics briefly.

Motor and vocal tics can be either simple or complex.

Simple motor tics involve just one muscle group, for example, an eye blink, a head jerk or a shoulder shrug. Complex motor tics use more muscles. The face or body may contort. The person may touch someone, sniff, jump, or make an obscene gesture. Sometimes a person will make a voluntary movement in order to cover up the tic, for example, a head thrust followed by smoothing the hair. Simple vocal tics include such sounds as grunting, barking, yelping and throat clearing. Complex vocal tics include syllables, words or phrases. During complex tics, a person with Tourette’s may repeat his or her own words, repeat another person’s words, or say obscene words or phrases.

The most dramatic symptoms are easy to notice, but the disorder can be very hard to recognize. People with mild to moderate tics may be too embarrassed to discuss their problems. Parents and teachers usually pay more attention to behavior, learning and attention problems. Sometimes tics are mistaken for other medical problems. For example, people might consult an allergist for sniffling or an eye doctor for unusual eye movements.

The disorder is diagnosed by observing the tics. If they do not occur frequently enough for a doctor to notice them during a routine visit, a family member or friend needs to describe them. A videotape can be very helpful. Sometimes, to help define the problem, a doctor asks a family member to fill out a questionnaire.

There is no blood test for Tourette’s syndrome. A physical examination and X-rays are usually normal.

Tourette’s syndrome is diagnosed when:

The person has multiple motor tics and one or more vocal tics.

Tics occur most days for at least one year.

The person was not free of tics for more than three months during the past year.

Symptoms began before age 18.

The tics are not caused by another illness, a substance or a medication.

The doctor also will want to know about the impact of the tics on daily life, and about other problems that commonly occur with Tourette’s, such as obsessions, compulsions, attention and learning problems, anxiety and changes in mood.

The symptoms of Tourette’s syndrome vary widely over time. No one can predict how long the illness will last in any one person.

On average, the first tics begin around age 7, and usually involve the eyes or face — eye blinking, grimacing, clearing the throat or sniffling. An intense period of tic activity often occurs from about age 10 to age 12. Usually, the severity decreases through the teen years and may disappear by age 20. Problems with attention and obsessive-compulsive symptoms can continue or become more obvious in adulthood. Even children with the most severe tics may have a good outcome.

The best treatment combines several approaches. The goal is to suppress tics and to identify and address related problems.

Education and supportA person with Tourette’s, along with family members, should be taught about the natural course of the disorder. Tics most likely will decrease in intensity and frequency as time passes. With proper treatment, tics need not impair life at school, at work or in relationships.

Self-help groups can provide support and education. Individual psychotherapy can help a person with Tourette’s cope with painful interpersonal problems, and feelings of embarrassment, low self-esteem and self-criticism. A therapist can provide support and help parents find an acceptable combination of sympathy and a firm hand, as they encourage their child to control unwanted behaviors.

Similar efforts may be needed at the child’s school. With the family’s permission, education and practical support may be provided to school administrators, teachers and peers.

Tic suppressionThe severity of tics often can be reduced with medications, behavior therapy or both.

The best known drug treatment, haloperidol (Haldol), is given in very low doses, and is effective in the majority of patients. Despite the low doses, side effects are common. They include sedation, weight gain, dry mouth and muscle stiffness. A similar medication, pimozide (Orap), can be less sedating, but it can affect the conduction of electrical signals in the heart.

Another commonly used medication, clonidine (Catapres), is less effective, but it often is tried first since it has side effects that are less troubling than medications like haloperidol. Clonidine has another advantage. It also is used to treat symptoms of ADHD, which accompanies Tourette’s in some people.

Behavior therapy is effective and can be used alone or together with medication. One type of behavior therapy is called habit-reversal training. The therapist teaches the person to use a specific muscle movement or behavior to compete with the tic. Other common behavioral techniques are positive reinforcement, relaxation training and self-monitoring, in which the person learns when tics are most likely to occur.

Treating other disordersOther psychiatric disorders should be treated when they appear. The most common related disorders are attention deficit hyperactivity disorder and obsessive-compulsive disorder. Someone with Tourette’s syndrome also may need treatment for broader problems, such as learning problems, depression, anxiety or relationship troubles.

Call your doctor or your child’s pediatrician if involuntary movements or sounds occur for more than a few weeks or months. Your doctor may refer you to a specialist if tics are very frequent or severe, or if there are other associated emotional or behavior problems.

Many patients experience significant improvement in their late teens or early 20s. Most people with Tourette’s syndrome get better as they mature. Some associated problems, such as obsessive-compulsive disorder and attention problems, can persist into adulthood and require long-term treatment.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

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